MEMBERS OF THE - Our Renfrewshire · 2015-05-29 · Members of the press and public wishing to...

Telephone: 0141 618 5967 Fax: 0141 618 7060 E-mail: [email protected] My Ref: CMacD/CCH&W Contact: Carol MacDonald Date: 28th February, 2014

MEMBERS OF THE COMMUNITY CARE, HEALTH & WELLBEING THEMATIC BOARD

Notice is hereby given that a meeting of the COMMUNITY CARE, HEALTH & WELLBEING THEMATIC BOARD will be held in CORPORATE MEETING ROOM 3, SECOND FLOOR, RENFREWSHIRE HOUSE, COTTON STREET, PAISLEY on WEDNESDAY, 5TH FEBRUARY, 2014 at 2.00 P.M.

The Agenda of business is attached.

Kenneth Graham Head of Legal & Democratic Services

Enc.

Members of the press and public wishing to attend the meeting and members of the Board from outwith Renfrewshire House should report to the Customer Service Centre where they will be met and directed to the meeting.

Finance & Corporate Services Director: Sandra Black CPFA

Head of Legal & Democratic Services: Kenneth Graham LLB dip L.P. Renfrewshire House, Cotton Street, Paisley PA1 1TR

www.renfrewshire.gov.uk

http://renfrewshire.gov.uk/

COMMUNITY CARE, HEALTH & WELL-BEING THEMATIC BOARD

Councillors I McMillan and M Brown (Renfrewshire Council); P MacLeod, Lead Officer and Director of Social Work; F MacKay, Renfrewshire Community Health Partnership (RCHP); S Dock, Engage Renfrewshire; S McLellan, Forum for Empowering Our Communities; P Nelis, Scottish Fire and Rescue Service; A Douglas, Police Scotland; A Cumberford, West College Scotland; A Bonar, University of the West of Scotland (UWS); D Goodman, Renfrewshire Carers; J McKellar, Renfrew Leisure Limited; Dr A Van der Lee, Greater Glasgow & Clyde NHS; D Reid, Renfrewshire ADP; R Telfer, Scottish Care; S Strachan, A McMillan, T Lavery, L McIntyre, R White, O Reid, L Muirhead and R Robertson (all Renfrewshire Council).

1. APOLOGIES

2. MINUTE OF MEETING OF BOARD HELD ON 4th DECEMBER, 2013

Submit Minute of meeting of the Community Care, Health & Well-being Thematic Board held on 4th December, 2013. (Copy herewith, pages 1 - 2)

3. ROLLING ACTION LOG

Submit Rolling Action Log by Clerk (Copy herewith, pages 3 - 4)

4. ACTION PLAN

Submit diagram relative to action plan and verbal update by S Strachan, Head of Adult Services. (Copy herewith, page 5)

5. WINE & SPIRIT RETAIL TRADE PROJECT FUNDING

Verbal update by Director of Social Work.

6. NO SMOKING DAY 2014 UPDATE

Submit report by CHP relative to “No Smoking Day 2014”. (Copy herewith, pages 6 - 7)

7. “FEEL GOOD RENFREWSHIRE” EVENT

Verbal update by Social Work on “Feel Good Renfrewshire” Event.

8. ADP UPDATE

Submit report by Renfrewshire Alcohol and Drug Partnership. (Copy herewith, pages 8 - 12)

9. CHANGE FUND 2013/2014 MID-YEAR REVIEW

Submit report by Social Work relative to Change Fund Mid-Year Review. (Copy herewith, pages 13 - 41)

10. JOINT COMMISSIONING PLAN FOR OLDER PEOPLE IN RENFREWSHIRE

Submit report by Social Work relative to the Older People's Joint Commissioning Plan - Key Issues. (Copy herewith, pages 42 - 45)

11. CLINICAL SERVICES FIT FOR THE FUTURE

Submit joint report by Social Work and CHP relative to a Clinical Services Review. (Copy herewith, pages 46 - 55)

RENFREWSHIRE COMMUNITY PLANNING PARTNERSHIP

MINUTE OF THE MEETING OF THE COMMUNITY CARE, HEALTH & WELL-BEING THEMATIC BOARD HELD ON 4th DECEMBER, 2013

PRESENT

Councillor I McMillan, P Macleod, Lead Officer & Director of Social Work, S Strachan, R Robertson, and O Reid (all Renfrewshire Council); J McKellar (Renfrewshire Leisure Limited); Superintendent A Douglas (Police Scotland); Dr A Van der Lee (Greater Glasgow & Clyde NHS); D Reid (Renfrewshire Alcohol and Drug Partnership); H Cunningham and C Walker (both Renfrewshire CHP); R Telfer (Scottish Care); and D Goodman (Renfrewshire Carers).

Councillor I McMillan, presided.

IN ATTENDANCE

C MacDonald, Senior Committee Services Officer (Community Planning, Renfrewshire Council).

APOLOGIES

Councillor M Brown, A MacMillan and O Reid (both Renfrewshire Council); A Cumberford (West College Scotland); P Nelis (Scottish Fire and Rescue Service); F Mackay (Renfrewshire Community Health Partnership); and A Bonar (UWS).

ACTION

1. MINUTE OF MEETING OF 11th SEPTEMBER, 2013

There was submitted the minute of the Community Care, Health & Well-being Thematic Board held on 11th September, 2013.

DECIDED: That the minute be approved Noted

2. ROLLING ACTION LOG

CCH&WB.29.05.13(5b)

Discussion took place on the possibility of the Wine & Spirits Retail Trade funding a project. Agreed that the Lead Officer and CAP meet to discuss development of project.

CCH&WB.11.09.13(4b)

Agreed that a short life steering group be set up to develop “No Smoking” initiative.

DECIDED: That the Rolling Action Log be noted.

Noted

Agreed

Noted

AGENDA ITEM NO. 21 of 55

3.

OBESITY There was submitted a report by the Head of Planning and Health Improvement, Renfrewshire CHP, providing background information on obesity, current activity to promote physical activity, healthy eating and weight management and seeking support from the Community Planning Partners for collective action. The report advised that according to the latest NHSGGC Health and Wellbeing survey 25% of the Renfrewshire population were currently obese compared to 19% for NHS Greater Glasgow & Clyde. Previous and ongoing projects were discussed and it was agreed that a showcase event in the shape of a Health Fayre be held in 2014 with healthy cooking demonstrations, drama and music to supplement the programme and J McKellar offered the Lagoon Leisure Centre as a venue. It was noted that media communication would be key along with targeting the right groups and GP surgeries. The Lead Officer advised that he was looking for all partners to be proactive and support the event. R Robertson intimated that the Food Policy launch could be linked in with the event. DECIDED: (a) That a Health Fayre be held in 2014 within Lagoon Leisure Centre

with the possibility of the event going out to specific local communities still to be identified;

(b) That an outline plan be developed with suitable dates and venues to be investigated; and

(c) That the Lead Officer discuss funding for the event with Chief

Executive and D Leese and put the item on the CMT for further discussion.

Lead Officer/RLL Lead Officer/Partners Lead Officer/CHP

3.

ACTION PLAN DEVELOPMENT There was submitted a report by the Director of Social Work Services providing an action plan framework including potential activities and partner resources identified by members of the Board during the workshop session which took place on 11 November, 2013. The overarching priority actions within each outcome were discussed. DECIDED: That a task group be set up, to be led by S Strachan, to examine and prioritise the action plan, remove repeats, identify where some actions would sit with other groups and bring the action plan back to the Board for approval.

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1. Introduction

The first No Smoking Day (NSD) was in 1983. Back then there were twice as manysmokers as there are today. The current prevalence is 24% (GG & C Health & WellbeingSurvey 2011).

The purpose of NSD is to encourage smokers to quit. It provides an opportunity for localsmokefree services to promote the support services available to the public. It is also anopportunity to plant a seed in the minds of smokers who may have never consideredstopping smoking. No smoking day 2014 is on the 12th of March.

2. Planning No Smoking Day Activity for Renfrewshire

In Renfrewshire we have built up many years experience of running and co-ordinatingevents for NSD. Each year a steering group is established to plan the activity. The currentsteering group has representatives from; Renfrewshire Tobacco Alliance, RenfrewshireCouncil, Renfrewshire Leisure, Fire & Rescue, and Renfrewshire CHP.

3. Activities Planned

3.1 Prior to No Smoking Day 2014

On February 26th & March 5th 2014, there will be a Body Works Exhibit at Pharmacy in Paisley Centre. The local smoking programmes and smokefree pharmacy services will be promoted using timetables distributed to GP practices throughout Renfrewshire. In previous years Paisley Express have run a “Where is Mr Cig“competition during the week running up to NSD, and are negotiating a similar collaboration this year.

To: COMMUNITY CARE, HEALTH AND WELLBEING THEMATIC BOARD

On: 5th February, 2014

Report by: Heather Cunningham, Renfrewshire CHP

NO SMOKING DAY 2014 UPDATE


3.2 On No Smoking Day 2014 The CHP Health Improvement team will promote NSD at Morrisons, Johnstone & Asda, Linwood. Resources and interactive materials will be available to the general public at these venues.

3.3 A “rest & be thankful walk”, in Johnstone, a walk being organised by the walking development officer, for people who have given up smoking and would like to support NSD. A smoking cessation advisor will assist the development officer lead the walk along with Mr Cig.

3.4 Four Community Nurseries have registered interest in supporting NSD:

• Rainbow Nursery, Fullerton Street, Paisley • West Johnstone Pre 5 Centre • Our Lady of Peace Nursery, Paisley • Douglas Street, Pre 5 Centre

These nurseries plan to run stalls and engage parents, using NSD resources; quizzes, leaflets and information sheets.

3.5 Six Pharmacies will set up stalls in Paisley town centre.

3.6 The Alcohol Problems Clinic at Dykebar Hospital plan to set up a stall and promote NSD with their clients.

3.7 Renfrewshire Leisure plan to set up stalls at four of their sports centres. The stalls will be promoted by Live Active advisors who also plan to wear NSD t- shirts, the week before NSD, at their groups.

3.8 Trading Standards will provide an information point, in Renfrewshire House, to raise the issue of young people and proxy sales of cigarettes.

3.9 The RAH hospital smoke cessation team will provide information to staff, patients and visitors

3.10 RAMH will involve clients in a prize quiz and give information on the support available.

4. Additional Opportunities

4.1 Opportunities are currently being pursued with St Mirren football club, West College Scotland, West of Scotland University and Kibble Education and Care.

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1. Summary

1.1 The purpose of this report is to update the Community Care, Health and Well Being Thematic Board on the work of the Renfrewshire Alcohol and Drug Partnership (ADP).

2. Recommendations

2.1 It is recommended that members note the contents of the report.

3. Background

3.1 ADP Improvement Event

On 28th March 2014, Renfrewshire ADP will host an Improvement Event. Facilitated by colleagues from the Scottish Government, the event will focus on lean thinking and quality improvement.

The day aims to increase stakeholders’ knowledge of capacity and demand in services, and how these can be most effectively managed. It also increases awareness of how system design and mistakes can significantly impact on individuals’ wellbeing and the effectiveness of treatment and care. The use of cost effective improvement goals will be promoted during the Improvement day as part of the PDSA improvement model (Plan, Do, Study, Act) to test change locally.

To: COMMUNITY CARE, HEALTH & WELLBEING THEMATIC BOARD


Report by: Donna Reid, Renfrewshire Alcohol & Drug Partnership

ADP UPDATE


This method will also be applied to ensure the ADP meets their key aim statement -

• 7% of individuals involved in services will be offered access to preparatory work who are directed and supported to access training and/or employment by end of 2015.

If you would like to attend, please contact [email protected] 3.2 NHS Health Scotland Research ‘A comparison of alcohol sales and alcohol-related

mortality in Scotland and Northern England’ Health Scotland has published a study on alcohol sales and alcohol related mortality. The

aim of the research was to assess population levels of alcohol consumption based on retail sales data within particular regions, comparing with levels of alcohol related mortality.

Alcohol related mortality is substantially higher in Scotland than other countries in the

UK. Using alcohol sales data from market research specialists, estimates of population alcohol consumption in Scotland, North East England and North West England were analysed alongside alcohol related mortality data for the same regions.

Results showed that 23% more alcohol (9.0L) was sold per capita in Scotland than in England and Wales (7.3L). Per capita sales were 13% and 12% higher in Central Scotland than in North East England and North West England respectively. Spirits accounted for a much higher market share in Central Scotland than regions in Northern England.

In 2011, alcohol related mortality was 80% higher in Scotland than in England and Wales.

Central Scotland had 14% higher than the Scotland average and 67% higher than NE England and 47% higher than NW England.

The report concludes that regional comparisons of alcohol related mortality and

previously unavailable alcohol retail data in Scotland and Northern England show that alcohol related mortality is generally higher in areas with higher per capita alcohol consumption levels. However, for Central Scotland the relationship is more complicated; the region has a higher level of alcohol related mortality than Scotland as a whole despite similar consumption levels.

The full report can be accessed at

http://www.healthscotland.com/uploads/documents/22520-MESAS%20-

%20Regional%20alcohol%20sales%20and%20mortality%20-%20Dec%202013.pdf

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mailto:[email protected]

http://www.healthscotland.com/uploads/documents/22520-MESAS%20-%20Regional%20alcohol%20sales%20and%20mortality%20-%20Dec%202013.pdf

http://www.healthscotland.com/uploads/documents/22520-MESAS%20-%20Regional%20alcohol%20sales%20and%20mortality%20-%20Dec%202013.pdf

3.3 Naloxone Consultation

The Medicines and Healthcare Products Regulatory Agency (MHRA) is seeking feedback on a proposal to allow wider access to naloxone* for the purpose of saving life in an emergency. This would be achieved by an amendment of the Human Use Regulations 2012. The proposal is aimed at reducing deaths from heroin overdoses. The consultation document has been jointly produced by the UK Health Departments and the MHRA.

The proposal is requesting the following amendments:

• to allow people providing drug treatment services to supply naloxone to anyone requiring access to it for use in an emergency

• allow family members or carers to receive direct supplies of naloxone which they can administer in an emergency

Renfrewshire ADP has submitted a response supporting the proposals to MHRA.

*Naloxone is a drug used to counter the effects of an opiate overdose. 3.4 Renfrewshire ADP Website Renfrewshire ADP's new website was launched in January 2014. The website displays

information on the work of the Renfrewshire ADP including ADP strategies, minutes of meetings and news about ADP events.

The website is also a resource which promotes drug and alcohol services in Renfrewshire,

detailing referral pathways for accessing treatment, location of services and treatment options.

Log on to www.renfrewshireadp.co.uk to keep up to date with the work of Renfrewshire

ADP. If you are working on any drug or alcohol related projects you would like highlighted on

the website please contact [email protected] 3.5 ADP Management Information

The ADP continues to monitor the following performance indicators:

HEAT Target: Access to Drug and Alcohol Treatment Services

The national HEAT (Health Improvement, Efficiency, Access, Treatment) target (A11) expects that 90% of people who need help with their drug/alcohol problem will wait no longer than three weeks for treatment.

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http://www.renfrewshireadp.co.uk/


Current performance for period relating to July – September 2013 shows that 98.5% of all

individuals accessing drug and alcohol services waited no more than three weeks which exceeds current HEAT target of 90%

Alcohol and Brief Interventions* - HEAT Target - Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 Guidelines

Current performance in Renfrewshire for the period April – September 2013 – 568 against

target of 561 - target exceeded. (*ABIs are time-limited interventions that focus on changing drinking behaviour and have

been defined as: ‘…a short evidence-based, structured conversation about alcohol consumption with a

patient/service-user that seeks in a non-confrontational way to motivate and support the individual to think about and/or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm’ (HEAT H4 National Guidance on Data Reporting (NGDR), 2011, Page 3).

3.6 STAR Outcome Tool

This table one below shows the average first and last scores based on 425 clients which are included in this summary. The difference between the initial and final is the 'change', or outcome, shown in the column on the right. The majority of scores have improved with the exception of accommodation which has seen a decrease. The biggest improvements can be seen in alcohol, social networks and emotional health.

Table One

Date: 12th Nov 2013

Renfrewshire Drug and Alcohol Services

Scale Initial Final Change Alcohol 8.0 8.6 0.6 Physical health 6.9 7.2 0.3 Use of time 6.3 6.8 0.5 Social networks 6.1 6.7 0.6 Drug use 7.6 7.9 0.3 Emotional health 6.1 6.7 0.6 Offending 8.9 9.0 0.1 Accommodation 8.2 8.1 -0.1 Money 7.4 7.8 0.4 Family and relationships 7.2 7.7 0.5 Average 7.3 7.7 0.4

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Table two shows the average proportion of clients included in the report whose score for a scale has increased, decreased or stayed the same. The biggest improvement can be seen around use of time, social networks and emotional health.

Table Two

Date: 12th Nov 2013

Renfrewshire Alcohol and Drug Services

Scale Decrease Same Increase Alcohol 16 % 48 % 36 % Physical health 28 % 31 % 41 % Use of time 26 % 26 % 48 % Social networks 26 % 26 % 48 % Drug use 24 % 39 % 37 % Emotional health 26 % 25 % 49 % Offending 17 % 63 % 20 % Accommodation 29 % 42 % 29 % Money 26 % 34 % 40 % Family and relationships

23 % 36 % 41 %

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1. Summary

1.1 This report seeks to update the Board on the content of the submission of the MidYear Review Report on the Renfrewshire Reshaping Care for Older People [ChangeFund] to the Scottish Government in October 2013 and builds on the previousreports to this Board on the workstream.

1.2 The Renfrewshire Reshaping Care for Older People Partnership submitted a MidYear Review report on Year 3 of this Change Fund programme to the ScottishGovernment’s Joint Improvement Team in October 2013.

1.3 The Change Fund Implementation Sub Group agreed the draft report at its meetingof 15 October 2013.

1.4 The Review Report included a self assessment by the Change Fund ImplementationSub Group of the Renfrewshire Partnership’s progress in achieving the ReshapingCare outcomes as set out in its Change Fund Plans.

2. Recommendations

2.1 It is recommended that the Board note the draft Mid Year Review report submittedto the Joint Improvement Team in respect of Year 3 of the Renfrewshire ChangeFund programme, attached at Appendix One to this report.



Report by: Director of Social Work

CHANGE FUND 2013/2014 MID YEAR REVIEW


3. Background

3.1 The Reshaping Care for Older People Change Fund is a 4-year programme

established by the Scottish Government to support local partnerships to develop and deliver services to older people that will support a shift in the balance of care by optimising independence and well-being and supporting older people to stay at home or in a homely setting for as long as possible. The Fund also supports a shift from the present level of investment in bed-based provision in hospitals and care homes. The Change Fund also provides resources to support unpaid carers and to develop preventative services within local communities.

3.2 Using this Change Fund to support the reshaping of services for older people, the Partners are delivering a range of projects, service redesign and capacity-building initiatives under the four streams of development work:

• Preventative and anticipatory care

• Pro-active care at home

• Effective care at times of transition

• Hospital and care homes

3.3 The Scottish Government’s allocation for 2013/2014 to Renfrewshire’s Change Fund

programme is £2.14m, with an additional Council contribution of £650,000, bringing the total to £3.1m.

3.4 As indicated in the Board report of 5 March 2013, Year 3 of the Change Fund has

seen a consolidation of work undertaken in Years 1 and 2 and this was reflected in the Mid Year Review Report.

3.5 The Mid Year Review Report advised the Joint Improvement Team that: a) The Renfrewshire Partnership has applied needs analysis in decision-making,

using an evidence base which includes the findings of consultations with service users and carers and other stakeholder groups;

b) Proposals for this Change Fund have been assessed against the key outcomes- reducing levels of delayed discharge from hospital, avoiding unnecessary admission to hospital and capacity building;

c) The Partnership agreed (15 October 2013) a set of options appraisal criteria

and methodology to be applied to Change Fund initiatives among other proposed changes and service developments being considered as part of the 10 Year Joint Commissioning Plan process to be completed by December 2013, which will be the subject of a separate report to this Board in March 2014.

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Current Change Fund Activity

Preventative and Anticipatory Care

3.6 The Renfrewshire Partnership is a partner in the European SmartCare Initiative, focusing on dementia and falls prevention- for the Renfrewshire Partnership the focus is on falls which are a key factor in people losing mobility, confidence and independence. The Partnership is working with other Smartcare partners to develop improved, evidence-based and consistent care pathways in relation to falls. The Renfrewshire Falls Subgroup, which is representative of all Health & SW partner agencies including, the Scottish Ambulance Service and Care Home Sector, is benchmarking the local position against 'Up & About' good practice document.

3.7 The Partnership is also involved in a second European initiative, United 4 Health (U4H), which focuses on the management of long term conditions. Self management of long term conditions can support people to live at home, or in a homely setting, linking with community health services in a planned way rather than being susceptible to hospital admissions arising as a result of a crisis or unexpected worsening of ill health. Local activity on self management includes the work of the health improvement team and community development approaches such as AgeFest (annual event promoting healthy lifestyles by and to older people in Renfrewshire).

3.8 The Partnership also supports the implementation of the NHS GG&C framework on supported self care, with a range of activity around patient information, patient education and peer support. Support for self management is provided via the Rehabilitation and Enablement Service (RES) and Care at Home and telecare service).

Proactive Care at Home

3.9 The Change Fund has been used to add capacity to the housing aids and adaptations programme locally, to provide housing advice for older people, a handyperson service, access to social activities and the Third Sector Food Train shopping service.

3.10 The Food Train began recruiting local volunteers in September and now has 45 customers, currently mainly in the Paisley area. The Food Train is targeting other towns and areas in Renfrewshire to promote the service. 39 of its current customers are over the age of 70 years. 21 customers are over the age of 80 years. The Food Train’s recent formal launch in the Paisley Town Hall on 6 December brought together volunteers, customers and representatives of the Renfrewshire Partnership and local stakeholders.

3.11 The Partnership is also supporting the delivery of the platinum telecare services which support people to live at home. The further development of telecare services has been supported by the Change Fund.

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3.12 The Change Fund is currently funding two reviews of housing for older people –

extra care housing and sheltered housing, the studies being undertaken by Craigforth Research Unit, with reports expected to be available to the Partnership early next year to inform the design of housing with support models as part of the 10 year Joint Commissioning Plan.

Hospitals and Care Homes

3.13 In relation to specialist clinical advice for community teams, local spread and impact of the Change Fund activity are good. The Change Fund has supported the development of links between specialist consultants at the RAH and community health services e.g. in the provision of rapid access clinics to which GPs can refer older patients for diagnosis without requiring admission to hospital.

3.14 This Change Fund has also supported the targeting of resources to build strong links between primary care services and care homes, providing specialist staff (e.g. tissue viability nurse, podiatrist, Community Psychiatric Nurse support) and supporting GP engagement with care home residents, their families and care home staff in anticipatory care planning.

3.15 The Joint Commissioning Plan steering group has engaged the specialist staff at the hospital, the care providers forum and the GP forum in discussions about the 10 Year Joint Commissioning Plan.

Carers Support

3.16 The Partnership is working to further develop progress around carers’ pathways and support in the hospital settings. It should be noted that early feedback on the Change Fund initiative “Carer Pathway Liaison”, the post managed by the Renfrewshire Carers Centre, is very positive and improvements in this area are anticipated.

“Enablers” – Joint Commissioning 3.17 In relation to commissioning, there is currently a great deal of activity on

partnership work on joint commissioning to establish development agreements on investment proposals and shifting resources. The 10 Year Joint Commissioning Plan is expected to be completed in Dec 2013 following a public stakeholder engagement on 22 November 2013 which was the culmination of a programme of development and consultation over the summer and autumn 2013. The 10 Year Joint Commissioning Plan will provide a strategic framework for future commissioning of services.

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4. Resources

4.1 The Scottish Government’s allocation for 2013/2014 to Renfrewshire’s Change Fund

programme is £2.14m, with an additional Council contribution of £650,000, bringing the total to £3.1m.

5. Prevention

5.1 A key work stream in the Change programme is to develop and support preventative

action and early intervention on health, social care and well-being for older people. The partnership approach seeks to develop preventative action across all the partners: statutory, third sector and independent sector.

6. Community Involvement/Engagement

6.1 The Partnership has undertaken a wide range of stakeholder consultation and engagement throughout the Change Fund Programme. The most recent public stakeholder events included a dementia services planning event on 22 October 2013 and a consultation event held on 22 November 2013 to consider the development of the 10 Year Joint Commissioning Plan on Older People’s Health and Care Services.

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Appendix One

RENFREWSHIRE PARTNERSHIP

CHANGE FUND 2013/2014

MID-YEAR REVIEW REPORT

OCTOBER 2013

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Appendix One

Contact Details To ensure our records are up-to-date, please complete for all four partners: Joint Strategic and Operational Leads Name Shiona Strachan Job Title Head of Adult Services, Social Work Email Address [email protected]

Telephone # 0141 618 6828 Name Sylvia Morrison Job Title Head of Primary Care and Community Services,

Renfrewshire CHP Email Address [email protected]

Telephone # 0141 618 7640 NHS(Acute) lead Name John Kennedy Job Title Head of Acute Services Email Address [email protected]

Telephone # 0141 314 7104 Third Sector Lead Name Alan McNiven Job Title Chief Executive, Engage Renfrewshire Email Address [email protected] Telephone # 0141 887 7707 Independent Sector Lead(s) Name Robert Telfer Job Title Development Officer Email Address [email protected] Telephone # 07789865858 Other Key Contacts (if any – e.g. overall Project Managers/Officers, Development Managers/Officers etc.) Name Teresa Lavery Job Title Change Fund Project Manager Email Address [email protected] Telephone # 0141 618 7049

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Appendix One

Carers Support Lead Name Diane Goodman Job Title Manager, Renfrewshire Carers Centre Email Address [email protected] Telephone # 0141 847 1931

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Appendix One

Change Fund 2013/14 – Mid-Year Review

Partnership Renfrewshire Contact Name(s) & Job Title(s)

Teresa Lavery Change Fund Project Manager

Email Address [email protected] Telephone # 0141 618 7049 Date of Completion

25 October 2013

1. Examples of impact

Please complete a case study template (Annex 1) describing at least one achievement that your partnership has made through use of the Change Fund for each of the Reshaping Care Pathway workstreams (i.e. we would like at least 5 in total to be submitted):

• Preventative and Anticipatory Care; Proactive Care and Support atHome; Effective Care at Times of Transition; Hospital and CareHome(s); Enablers.

Each case study should be no more than one page long, with at least one of the case studies highlighting either a direct or an indirect impact on carers. Question 7 below contains short descriptors of interventions in the pathway.

2. Learning from what hasn’t worked as well as anticipated

The Change Fund has been an opportunity for Partnerships to explore innovations that are ‘Proof of Concept’ or ‘Tests of Change’. Please describe any shareable learning gained from initiatives where a decision not to continue has been taken – e.g. where barriers to progress were encountered or the initiative was not found to be effective.

The Partnership funded an out of hours extension to the RES “return home” service for older people in A&E. The initiative is currently being evaluated, but early indications are that the service was not meeting the higher level of out of hours demand anticipated and the hours of service were calibrated accordingly. The lessons learned are the importance of constant review of services, performance and targets and the need for capacity to make changes in a reasonable timescale.

The Partnership is currently evaluating the Change initiatives introduced in Years 1 and 2 of the Change Fund programme. An evaluation report will be submitted to the next meeting of the Change Fund Implementation Sub Group in late November 2013.

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Appendix One

3. Option Appraisal Please describe any option appraisal approaches used to decide Change Fund investment priorities – e.g. whether applied to all / only selected initiatives and who was involved. The Renfrewshire Partnership has applied needs analysis, using an evidence base which includes the findings of consultations with service users and carers and other stakeholder groups. Proposals have been assessed against the key outcomes: reducing levels of delayed discharge, avoiding unnecessary admission to hospital and capacity building. A pro forma has been used and a Project Initiation Document required for every proposal, to support the Change Fund Implementation Sub Group in its appraisal of options. The process was adapted to support third sector and community engagement in the process. JIT contribution to the options appraisal process has been as a ”friendly challenger” and has been a regular input to the partnership activity. The Partnership has agreed (15 October 2013) a set of options appraisal criteria and methodology to be applied to Change Fund initiatives among other proposed changes and service developments being considered as part of the 10 Year Joint Commissioning Plan process to be completed by December 2013. 4. Use of Data and Information Please describe your local progress and any barriers to effective use of data and information between partners (both within and out with the statutory sector). There is in place an information sharing protocol in place between Renfrewshire Council and NHSGGC. Work is ongoing to develop effective data sharing arrangements locally. Sharing of basic service data has now become routine and effective trend information is now available to managers as well as a scorecard of performance indicators tracking progress in key areas. Access to the Edison database on delayed discharges has allowed the production of up to date management information to supplement the monthly information published by the ISD. The Joint Services are using the SWIFT client information data base but there are IT systems challenges for staff. We are developing portals locally, the plan being to pilot these initially in Children’s services. IRF and SPARRA data have been made available to the partnership.

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Appendix One

5. Improvement support Please provide details of any support you would welcome. The Partnership values the ongoing input from JIT as “friendly challenger” locally and its support to local partnership development work. The Partnership also values the national learning and benchmarking events which produce examples of good practice at a national level. The Partnership is also pleased to be using the input of the Institute of Public Care in the development of the 10 year joint commissioning plan.

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Appendix One

6. Budget 2013/14 Please insert details of your 2013/14 Change Fund budget and the proportion of spend aligned to each of these 5 workstreams:

2011/12 2012/13 2013/14 SG Allocation £2.110m £2.410m £2.410m Additional Local Resources (if any)

£0.650m £0.650m

Carry Forward £0.872m £0.912m Total Allocation £2.110m £3.932m £3.972m Year-end Spend £ £3.026m £3.543m

(anticipated)

Anticipated Carry Forward to 2014/151 £0.429m

Direct spend on carers (year-end spend)

N/A £42,000 £273,000 (anticipated)

Indirect spend on carers (year-end spend)

N/A 41% £1,436,932 (anticipated)

Preventative and Anticipatory Care

Proactive Care and Support at Home

Effective Care at Times of Transition

Hospital and Care Home(s)

Enablers

Total (should equal 100%)

2011/12 (year-end spend)

% 100% % % % 100%

2012/13 (year-end spend)

15% 30% 27% 24% 4% 100%

2013/14 (anticipated year end spend)

23% 34% 27% 13% 4% 100%

7. Assessment of Spread The Reshaping Care Pathway represents 4 ‘bundles’ of interventions, approaches or actions and the related enablers which collectively improve outcomes for older people. As you take forward Joint Commissioning, it is important to understand the extent to which you have spread new approaches and improvements so that you can understand where and when future gains can be anticipated. Therefore we invite Partnerships to complete a self-assessment of spread as at September 2013 by assigning a position statement 0-5 to each approach or intervention in the pathway.

1 Carry forward has been earmarked provisionally for areas of growth or pressure in community services – RES, care at home and care homes

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Appendix One

Spread Value

Self-Assessment Position Statement

0 No agreed plan to implement the approach / intervention / improvement action

1 Agreed plan to take forward the approach / intervention / improvement action but not yet began to implement

2 Testing / implementing the approach / intervention / improvement action in a minority of localities / sites / teams / older people / carers

3 The approach / intervention / improvement action has spread to most localities / sites / teams / older people / carers

4 The approach / intervention / improvement action has spread to all localities / sites / teams / older people / carers but is not yet fully embedded in routine practice

5 The approach / intervention / improvement action is fully embedded in all localities / sites / teams / older people / carers and there is an agreed plan to sustain this

Preventative and Anticipatory Care Value (0-5)

Build social networks and opportunities for participation

We are mobilising community support through volunteering, building community capacity, collaborations and social enterprises that promote participation and meaningful activity for older people living at home and in care homes.

2

Early diagnosis of dementia

We continue to work to increase the number of people with dementia who have a diagnosis as this improves access to support and services for the family.

3

Prevention of Falls and Fractures

The Partnership is implementing the recommendations of Up and About: a whole system pathway for the prevention and management of falls and fragility fractures.

2

Information & Support for Self-Management & Self-Directed Support

Practitioners and services signpost older people towards community and third sector resources that help them to stay well, to manage their conditions and provide useful and accessible information and advice on the choices they have about their future care, support and housing. This includes post diagnostic support for people affected by dementia and information and support required to adopt personal budgets.

3

Prediction of risk of recurrent admissions

Community health and social care teams routinely use a risk prediction tool (e.g. SPARRA) and local health and social care data and intelligence to identify older people who are frail and at greatest risk of emergency admission to hospital or care home.

3

Anticipatory Care Planning

Care providers support frail older people and their carers to develop Anticipatory Care Plans (ACPs): a summary or shared record of the preferred actions, interventions and responses in the event of an anticipated deterioration in the health of the person or their carer.

4

Support for carers

Our health and care staff routinely identify carers and are able to signpost them to information, advice and support from social work, carers centres and other agencies to help them to stay well and be supported to continue in their role.

3

Suitable and varied housing and housing support

We are investing in handyperson services, housing support, making better use of our existing stock of sheltered housing and developing new specialist provision to help older people maintain their independence and reduce the risk of accidents at home.

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Proactive Care and Support at Home Value (0-5)

Responsive flexible, self-directed home care

All providers of care and support at home adopt a “doing with” approach and formulate packages of care and support around the individual’s personal goals. This includes the opportunity to adopt personal budgets for care and support.

4

Integrated Case/Care Management

Multi-disciplinary community health and social care teams adopt an integrated case / care management approach to monitor and proactively support frail older people with complex and changing needs at greatest risk of emergency admission to hospital or care home.

4

Carer Support and Respite

We provide opportunities for short breaks to help carers continue to provide care, helping reduce isolation, providing a better quality of life and maintaining carers’ health and wellbeing.

4

Rapid access to equipment

There is effective and timely access to health and social care equipment and adaptations and this is an integral part of mainstream community care assessment and service provision.

5

Timely adaptations, including housing adaptations

We have streamlined access to adaptations and alterations which help older people to maintain their independence at home.

4

Telehealthcare The partnership provides remote monitoring and assistive technology for older people with complex care and support needs who require this technology to remain supported in their own home.

5

Effective Care at Times of Transition Value (0-5)

Reablement & Rehabilitation

Health and care practitioners adopt an enabling approach and all providers have a focus on maintaining independence, recovery, rehabilitation and re-ablement.

5

Specialist clinical advice for community teams

Primary and community health and care staff, including voluntary and independent sector partners, are supported by access to a range of specialist practitioners for advice on common important conditions in older people such as dementia, continence, nutrition and tissue viability.

4

NHS24, SAS and Out of Hours access ACPs

Community teams share essential information from ACPs (e.g. electronic Key Information Summary) with local emergency and out of hours services and with SAS and NHS24.

4

Range of Intermediate Care alternatives to emergency admission

Working alongside NHS24, SAS and Out of Hours services we provide rapid access to a range of enabling assessment and treatment services at home, in minor injuries units, day hospitals, community hospitals and care homes as safe and effective alternatives to acute hospital admissions and to support timely discharge.

4

Responsive and flexible palliative care

We provide timely access to community based support for palliative and end of life care to increase the proportion of older people who are able to die at home or in their preferred place of care.

5

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Effective Care at Times of Transition Value (0-5)

Support for carers

We promote shared decision making and make sure that carers are informed and supported to help them continue in their role when the health of the person they care for deteriorates or they move to another care setting.

4

Medicines Management

Joint working between GPs, community pharmacists, mental health teams and geriatricians reduces polypharmacy for older people through mindful prescribing, review and reconciliation of medicines and use of pharmaceutical care plans. We support older people and their carers to administer and take medication safely.

4

Access to range of housing options

The range of intermediate care services provided includes timely accessible housing options for people whose functional ability has acutely declined.

3

Hospital and Care Home(s) Value (0-5)

Urgent triage to identify frail older people

Pathways through A&E and admissions wards are configured to identify frail older people with physical, functional and cognitive impairments who will benefit from coordinated comprehensive geriatric assessment.

4

Early assessment and rehab in appropriate specialist unit

Frail older people with physical, functional and cognitive impairments and those who have fallen are ‘pulled’ to access multi-professional Comprehensive Geriatric Assessment within 24 hours of emergency admission to hospital.

4

Prevention and treatment of delirium

Pathways through acute hospitals minimise boarding for frail older people and care staff are trained to prevent, detect and effectively manage delirium.

3

Effective and timely discharge home or to intermediate care

All partners work together and with Scottish Ambulance Service to optimise use of estimated date of discharge, improve discharge planning and eradicate delayed discharges, including delays in short stay specialty beds and for Adults with Incapacity.

5

Medicine reconciliation and reviews

Medicine reconciliation is routinely undertaken for older people on admission and at discharge from hospital and care homes, and antipsychotic prescribing is minimised.

3

Carers as equal partners

We identify the carer at an early stage when the person is admitted to hospital and ensure that the carer is involved in the care, rehabilitation and discharge planning.

2

Specialist clinical support for care homes

We provide specialist clinical support to enable care homes to have a greater role in intermediate care and to support staff to care for older people with dementia and palliative / end of life care needs.

4

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Enablers Value (0-5)

Outcomes-focussed assessment

Our providers of care and support deliver personalised care through assessments which focus on personal outcomes and goals agreed with the older person (and their unpaid carer).

4

Co-production Services are planned and delivered in an equal and reciprocal relationship between professionals, people using services, their families and the community.

3

Technology/eHealth/Data Sharing

We routinely share information across professionals and teams in line with agreed data sharing protocols and using the capability of emerging technology.

3

Workforce Development/Skill Mix/Integrated Working

We are developing a multi-professional workforce that is integrated, capable and fit for the future with core generic skills and appropriate specialist competencies.

3

Organisational Development and Improvement Support

We engage and communicate effectively with all partners, with our workforce and the public, and collaborate across professions and sectors to strengthen strategic leadership for change and to build improvement capacity and capability.

4

Information and Evaluation

We routinely use measurement for improvement and feedback performance measures to our staff and to the public to lever and assure quality.

4

Commissioning and Integrated Resource Framework

Statutory, community, third and independent sectors, users, carers, providers and commissioners of care come together to agree long term service development and investment proposals including where and how resources should shift from current services and care models to new arrangements. We are using the Integrated Resource Framework to lever a shift in the totality of the partnership spend on service and support for older people.

2

8. Any additional comments? Preventative and Anticipatory Care In relation to falls prevention, it should be noted that there is a great deal of activity in service delivery and development and general agreement on forward planning issues to integrate the activity. The Falls Subgroup, which is representative of all Health & SW partner agencies including, SAS and Care Home Sector, is benchmarking the local position against 'Up & About' good practice document. We are also working with other Smartcare Scottish partners to develop improved, evidence based & consistent care pathway. We are working with IM&T to enable information sharing across partner agencies. This work is at an early stage, with future planning and development work being identified, but is progressing steadily. There has been a rise in the use of Direct Payments amongst older service users and their carers and there is a multi-service users steering group currently planning

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Appendix One

the roll out of DP with a pilot underway under the aegis of SDS. The Partnership is also supporting the delivery of the platinum telecare services which support people to live at home. The further development of telecare services has been supported by the Change Fund. The Change Fund is also providing match funding for the European Smartcare Initiative, which focuses on dementia and telecare. The Partnership also supports the implementation of the NHSGGC framework on supported self care, with a range of activity around patient information and patient education and peer support. Support for self management is provided via RES and care at home services and the telecare service. Local activity on self management includes the work of the health improvement team and community development approaches such as AgeFest (annual event promoting healthy lifestyles by and to older people in Renfrewshire). The Change Fund provides match funds for the European Initiative on the management of long term conditions, United 4Health. There is active development and roll out of the use of SPARRA amongst GPs in Renfrewshire, linking with RES to identify older people at risk of readmission to hospital and to support anticipatory care planning. Effective Care at Times of Transition In relation to specialist clinical advice for community teams, local spread and impact are good. The Change Fund has supported the targeting of resources to build strong links between primary care services and care homes, providing specialist staff (e.g. tv nurse, podiatrist, CPN support) and supporting GP engagement with care home residents, their families and care home staff in anticipatory care planning. In relation to access to a range of housing options, it should be noted that demand outstrips supply. Demand remains very high for specialist housing and for the range of adaptations for people to remain within their own homes. The Change Fund has been used to add capacity to the aids and adaptations programme locally, to provide housing advice for older people, a care and repair service, access to social activities and the Food Train shopping service. The Change Fund is currently funding two reviews of housing for older people – extra care housing and sheltered housing, the studies being undertaken by Craigforth Research Unit (reports expected to be available to the Partnership early next year) Hospitals and Care Homes In relation to carers as equal partners, we are working to further develop progress around carers’ pathways and support in the hospital settings. It should be noted that early feedback on the Change Fund initiative “Carer Pathway Liaison”, the post managed by the Renfrewshire Carers Centre, is very positive and improvements in

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Appendix One

this area are anticipated. Current work developing specialist support for care homes includes: -GNS support to Local Authority (LA) Care Homes in implementation of their Falls prevention & Management Strategy has demonstrated a reduction in falls & fractures in pre & post audit. - GNS Clinics in LA CHs has prevented avoidable hospital admissions through interface with Primary Care services & non medical prescribing - CPN attachment to CHs has supported CH staff in management of care for residents with complex & enduring mental illnesses. - Palliative care & EOL Care Pathway support provided by Macmillan GP Facilitator, Macmillan Nurse Specialist & local Hospices has improved the quality of care & residents choice through the use of ACPs(Anticipatory Care Plans) & SPAR ( Supportive Palliative Action Register ). - Introduction of the JIC (Just in Case) boxes in November will be supported in CH by DNS. - RES multidisciplinary support to CHs has prevented avoidable hospital admission, eg through medicines review by Interface Pharmacist & facilitated early supported discharge, eg through the rehabilitation programme in CH. The Partnership supported the establishment of a care providers’ forum and continues to support its regular meetings in pursuit of practice development. The forum supports sharing of good practice, information and access to training. The most recent meeting addressed a range of topics including infection control, oral health and end of life care practice. The forum has a high attendance level and is supported by the partnership’s representative from Scottish Care. In relation to medicines management, spread and impact are good but some services (e.g. pharmacy) may not be fully embedded yet. However, the majority of care homes are now engaging in one or more of the initiatives. This has been supported by the work of the Scottish Care officer whose post is funded by the Change Fund. Enablers In relation to technology, ehealth and data sharing, there is still room for improvement in relation to information management protocols and processes. In relation to commissioning and the integrated resource framework, there is currently a great deal of activity on partnership work on joint commissioning to establish development agreements on investment proposals and shifting resources. The 10 Year Joint Commissioning Plan is expected to be completed in Dec 2013 following a public stakeholder engagement which will be the culmination of a programme of development and consultation over the summer and autumn 2013. The 10 Year Joint Commissioning Plan will provide a strategic framework for future commissioning of services.

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Appendix One

In relation to IRF issues, the Partnership is working with ISD colleagues at national and local level to contribute to the development of the Information and Intelligence Framework to Support Health and Social Care Integration at national level. Thank you for taking the time to complete this mid-year review. Please return this template, along with at least 5 case studies using the pro-forma in Annex 1, to [email protected] by Friday 27 September 2013.

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Annex 1 – Examples of Impact

Partnership Renfrewshire

Name of Initiative Highlighted Rapid Response Team – Extended Service Hours

Date of Submission 25/10/13

Primary Contact Marian McGhee Email – [email protected] Telephone – 0141 618 7638

Pathway: Effective Care at Times of Transition Summary

The Partnership decided to extend the hours of the Rehabilitation & Enablement (RES) Rapid Response Team until 8pm to support older people being discharged from hospital and/or to prevent avoidable hospital admissions. The team works with hospital staff and care at home staff to support discharge from hospital to care at home or to care homes. The team supports triage at A&E to identify people who can receive community-based services as alternatives to hospital admission and liaises with other community services to put in place treatment, care & support packages, including community equipment, for patients in their own home. What was the issue you were addressing or working on?

Avoiding unnecessary hospital admissions & delays in patients discharge. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement)

A team of Nurses & AHPs has been established to provide rapid responses to GPs and hospital staff for patients whose admission to hospital can be prevented or whose discharge from hospital can be accelerated through provision of treatment & support from community health services. The team provides an out of hours service until 8pm to increase accessibility & potential for early supported discharge from A&E and prevention of avoidable hospital admission into the early evening. The team respond to referrals from A&E within 1 hour & to referrals from GPs within 4 hours. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?)

This initiative has enabled community health services to offer community-based options, into the early evening, to older people which prevent unnecessary hospital admission and has contributed to the very significant reduction in bed days lost due to delayed discharge, supporting patients to return home with an appropriate health and care package which is tailored to meet their needs & those of their carers. The initiative is funded until the end of March 2014 & is currently being evaluated to inform long term plans.

Additional contacts (to find out more) (People, organisations, link(s) to further information, if available)

Pauline Robbie – RES Team Lead – Paisley – 0141 618 5613 Craig Ross – RES Team Lead – West Renfrew – 0141 314 4612

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Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies please enter a Y into each and every box you think this applies to, being cognisant of the primary pathway chosen on the previous page: Preventative

and Anticipatory

Care

Case Study

Proactive Care and Support at

Home

Case Study


Case Study


Case Study



Reablement & Rehabilitation y











Rapid access to equipment y


y


y






Telehealthcare Support for carers

y Carers as equal partners

Support for carers

y Medicines

Management


y



Enablers

Outcomes-focussed assessment y Co-production Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working Y OD and Improvement Support Information and Evaluation y Commissioning and Integrated Resource Framework

Partnership Renfrewshire

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Name of Initiative Highlighted Carer Pathway Liaison Date of Submission 25/10/13 Primary Contact Diane Goodman Email [email protected] Telephone # 0141 887 3643 Pathway: Preventative and Anticipatory Care Summary The Carer Pathway Liaison Worker’s post is there to develop and maintain a clear carer pathway within health and social care. This includes a pathway for staff to refer carers to the centre. The aim is to educate staff so they can identify more carers of older people and refer them to the centre for support, thus enabling them to continue in their caring role. The post involves developing partnership working with health and social care staff and delivering training to these teams to increase their carer awareness. What was the issue you were addressing or working on? Avoiding unnecessary admissions to hospital and reducing delayed discharge through supporting carers in their caring role. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement) -educating health and social care staff on the importance of their role in the identification of carers and referral processes; jointly identifying and addressing training needs for carers with RES & DN staff and care at home staff; 2 half days spent weekly within the 2 RES teams- informing staff of the centre services and encouraging them to identify carers; shadowing RES staff on home visits was undertaken in the early months; going on joint home visits with staff where requested; encouraging staff to distribute and ideally support carers to complete carer self- assessments and the full Carers Assessment; jointly facilitating the Carers Champion group; initial links with the discharge team at the RAH; establishing links with social work locality teams, learning disability, and sensory impairment teams- had initial contact with team leaders What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) Health and social care staff are becoming more carer aware; strengthening partnership working between the centre and health and social care teams; new Carers of older people are being identified by staff and referred on for support; 52 new referrals to the carers centre from work with health and social care staff; new training courses being designed for carers; new support groups established for carers; as the post is developing, staff are requesting joint visits to families with the Carers Worker

Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) Diane Goodman, Manager Renfrewshire Carers Centre [email protected] Marian McGhee, chair, Joint Planning Performance and Implementation Group for Carers [email protected] Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following

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search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies please enter a Y into each and every box you think this applies to, being cognisant of the primary pathway chosen on the previous page: Preventative

and Anticipatory

Care

Case Study

Proactive Care and Support

at Home

Case Study


Case Study


Case Study










Carer Support and Respite Y











Anticipatory Care Planning Telehealthcare Support for

carers

Y Carers as equal partners

Support for carers Y

Medicines Management




Enablers

Outcomes-focussed assessment Y Co-production Y Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working

OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework

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Partnership Renfrewshire Name of Initiative Highlighted Community Geriatrician Date of Submission 25/10/13 Primary Contact John Kennedy Email [email protected] Telephone # 0141 314 7104 Pathway: Hospital and Care Home(s) Summary The Change Fund supports a community geriatrician post at the RAH, providing early assessment at day hospital and rapid access clinics as means of comprehensive geriatric assessment and admission avoidance. The post holder also provides specialist advice to GPs, to the Rehabilitation and Enablement and DN Services and Care Homes. The rapid access specialist clinics take referrals from GPs and advise the community health services of alternatives to hospital admission when appropriate. The post holder participates in quarterly meetings where hospital and community health and care staff meet to consider operational improvement areas in services and pathways for patients. What was the issue you were addressing or working on? Avoiding unnecessary admissions to hospital by supporting community-based alternatives to hospital admission. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement) The Partnership agreed to allocate Change Fund monies to support this post, based in the hospital but working across hospital-based and community health services, building links between specialist hospital services and GPs and Care Homes in particular, providing early assessment day clinics and specialist advice to community health staff. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) Older people have rapid access to hospital-based assessment services without having to be admitted to hospital unnecessarily. Community health staff have speedy access to specialist advice in provision of treatment and services for older patients. The post is currently funded to the end of the Change Fund programme.

Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) [email protected] [email protected] [email protected]

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Once submitted, this case study will be published to the JIT website. To help users find case studies relevant to their area of interest, this case study should be tagged with the following search terms (e.g. Reshaping care, re-ablement, community capacity, third sector, preventing admissions, intermediate care) In order to help us best sort the case studies please enter a Y into each and every box you think this applies to, being cognisant of the primary pathway chosen on the previous page:

Preventative and

Anticipatory Care

Case Study


Home

Case Study


Case Study


Case Study





Y




Y


Y
















Support for carers

Medicines

Management




Enablers

Outcomes-focussed assessment Co-production Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working Y OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework

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Partnership Renfrewshire Name of Initiative Highlighted Telecare Date of Submission 29/10/13 Primary Contact Lorna Muir Email [email protected] Telephone # 0141 618 5638 Pathway: Proactive Care and Support at Home 1. Summary The Partnership has allocated Change funds to provide a range of telecare packages for older people living at home, and an installation service provided by appointed technicians. . This has reduced delays in installing telecare equipment needed for older people with a care package and complements the reablement approach to care at home, offering people support at home while promoting independent living. 2. What was the issue you were addressing or working on? The initiative was supported by the Partnership which wished to reduce levels of delayed discharge from hospital by eliminating or minimising waiting times for telecare installation to support older people living at home with a care package. 3. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement) The Change Fund provided a budget for the appointment of telecare technician staff and a range of telecare equipment for installation (non recurring) as well as multi funcational assistive technology . 4. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) Benefits are currently ongoing, minimising waiting times for telecare equipment for people either being discharged from hospital or in supporting a care at home package that helps avoid unnecessary admission to hospital. The assistive technology supports the assessment and risk management strategies for people living at home in the community and also enhances quality of life through meaningful activity. The Change Fund funding for equipment was non recurring in Year 2; the funding for the Telecare technicians is currently scheduled to terminate at the end of the Change Fund programme

5. Additional contacts (to find out more) (People, organisations, link(s) to further information, if available)

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Preventative and

Anticipatory Care

Case Study


Home

Case Study


Case Study


Case Study



Y Reablement & Rehabilitation


Y




Y


Y


Carer Support and Respite Y




Rapid access to equipment Y








Telehealthcare y Support for carers


Support for carers

Medicines

Management




Enablers

Outcomes-focussed assessment Co-production Technology/eHealth/Data Sharing Y Workforce Development/Skill Mix/Integrated Working OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework

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Partnership Renfrewshire Name of Initiative Highlighted Workforce Development - Dementia and

Palliative Care Date of Submission 25/10/13 Primary Contact Lorna Muir Email [email protected] Telephone # 0141 618 5638 Pathway: Enablers Summary The Partnership has allocated Change Fund monies to develop and roll out training for home care and care home staff in dementia and palliative care. This allows the delivery of packages of care in people’s homes or care homes which supports them to live as independently as possible in the community for as long as possible, avoiding unnecessary hospital admissions. It also supports the ACP approach to supporting older people and their carers plan for future care needs, offering care at home or home care options to meet needs associated with dementia and palliative care. What was the issue you were addressing or working on? Reducing levels of delayed discharge from hospital by providing specialist care at home or in care homes in the community; avoiding unnecessary admissions to hospital by supporting community-based alternatives to hospital admission; expanding and promoting choices for older people in anticipatory care planning; ensuring staff have the right skills to be able to appropriately and effectively support people at home. What did you do? (Intervention(s), organisations involved, when it happened, development or tools used including use of Change Fund, JIT involvement) The Partnership agreed to allocate Change Fund monies to support the development of workforce training in care at home and care home staff in dementia and palliative care. What were the outcomes/benefits or otherwise? (What happened and what was gained or lost from this? When were the benefits realised? Would you do anything differently? What is/was your timeline?) Older people with dementia or palliative care needs have the option of remaining at home/in their care home or returning home or to their care home after hospital, with staff being trained to provide the specialist care needed. The training programme being offered to care at home staff is currently funded to the end of the Change Fund programme but will continue thereafter through facilitator training that is accredited to allow continuous development.

Additional contacts (to find out more) (People, organisations, link(s) to further information, if available) The training for care at home staff is being supported through Stirling Dementia Services Development Centre self study courses. Further details are available from Stirling or from Renfrewshire Care at Home service Managers.

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Preventative and

Anticipatory Care

Case Study


Home

Case Study


Case Study


Case Study



Y Reablement & Rehabilitation














Y




Y Medicine reconciliation and reviews




Support for carers

Medicines

Management




Enablers

Outcomes-focussed assessment Co-production Technology/eHealth/Data Sharing Workforce Development/Skill Mix/Integrated Working Y OD and Improvement Support Information and Evaluation Commissioning and Integrated Resource Framework

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1. Summary

1.1 The Scottish Government requires all local partnership areas to develop and publish a 10-year strategic Joint Commissioning Plan for older people’s services. Work in Renfrewshire has been progressed through the Change Fund subgroup, which reports into the Joint Planning and Performance Implementation Group for Older People. The sub-group has representation from health and social care, from housing, from the third sector (through Engage) and independent sector (through Scottish Care) and from the Scottish Government’s Joint Improvement Team. The group has undertaken an extensive consultation programme with wider staff and professional groups, providers, service users and carers, which has built on the consultation activities undertaken as part of the preceding 3 year plan for older people in Renfrewshire. The 10 year plan is currently being finalised and will be submitted for approval through the relevant Council policy board and CHP Committee in May 2014, and subsequently to the Scottish Government. The plan will be dynamic and subject to ongoing review and challenge.

1.2 The purpose of this paper is to provide an update to the thematic board on the work undertaken to date and on the important role that community planning partners have had and will continue to play in terms of driving this plan forward.

2. RecommendationsIt is recommended that Members of the group note the work undertaken locally to dateto develop the 10 year plan for older people’s services.


On: 5th February 2014

Report by: Shiona Strachan, Head of Adult Services, Renfrewshire Council

Sylvia Morrison, Head of Primary and Community Care Services, Renfrewshire CHP

JOINT COMMISSIONING PLAN FOR OLDER PEOPLE IN RENFREWSHIRE


3. Background 3.1 Over the past 18-24 months, local partners have been working together to develop a 10

year plan for older people’s services in Renfrewshire in response to the Scottish Government’s Reshaping Care for Older People Agenda.

3.2 The co-ordination of the plan (which is commonly referred to as the Joint Commissioning Plan) has been led through the local Change Fund Implementation Sub Group and has involved partners from health and social work, housing, the third sector, independent providers, and service users and carers. An associate from the Joint Improvement Team has supported this work locally, and the group has also obtained professional support from the Institute of Public Care.

3.3 A stakeholder consultation event was held on 22 November 2013 to discuss key elements of the draft Plan and the proposed direction of travel in the key service areas in health and social care. The input from the stakeholder event is currently being analysed for its contribution to the final stages of the draft Plan. This event was the culmination of a series of consultations, formal and informal, with a range of stakeholders over the summer and autumn of 2013. A number of workshops took place on issues such as frailty, dementia and falls, and these have involved providers, service users, carers, statutory agencies, the independent sector, the third sector and community representatives.

3.4 The draft plan sets out in detail the partners’ strategic approach to the commissioning of services, taking into account local demographics, the local market in health and social care service provision, national policies and resource management issues. The plan expresses people’s needs and choices in the planning of services in their communities.

3.5 The Plan will be in three major sections:

• Needs analysis, trends analysis, policy overview (updating the three year plan material from Feb 2013), scenario-testing on key service areas or pathways to assist in service planning and options appraisals;

• Strategic Commissioning Action Plans under each of the long term strategic priorities for Shifting the Balance of Care; and

• A Market Position Statement 3.6 Local partners will engage stakeholders throughout the life of the plan to review and

update it regularly. The Partnership views the 10 Year Plan as a strategic framework, or “road map”, which will guide and support decision-making based on evidence and local partnership and stakeholder engagement. The Partnership is aware that many external factors may impact on a 10 Year Plan and that consequently the Plan must be reviewed regularly and revised where appropriate to continue to make progress in achieving the long term strategic outcomes agreed for Renfrewshire services.

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Stakeholder event – November 2013 3.7 At the public stakeholder event on 22 November 2013 a wide range of stakeholders

considered the progress made to date in reshaping care for older people in Renfrewshire:

• Keeping older people out of hospital through providing community based health and

social care as alternatives to hospital admission

• Reducing delayed discharge from hospital to help older people settle back home or in a homely setting following hospital treatment

• Providing joint and integrated health and social care in the community

• Making it easier for older people to live in their own homes or in homely settings

• Helping carers to continue to care

• The Renfrewshire Partnership’s success in reducing bed days lost due to delayed discharge has placed it at the top of performance across Scotland.

• The stakeholder event also considered changing health needs and future challenges in the provision of health and social care.

• building capacity with third sector and community-based partners to develop sustainable community action and engagement in the RCOP programme.

4. Resources

4.1 Current projections in public finance in general and in health and care budgets suggest that financial resources are unlikely to increase and may reduce in real terms. At a time of financial constraints which coincides with an expected growth in demand, commissioners of services for older people face challenges in service developments and resource management. In the short to medium term the Partnership has identified key resource management challenges for the successful implementation of the 10 Year Joint Commissioning Plan:

• maintaining success in reducing bed days lost due to delayed discharge while meeting the consequent increasing demand on the community –based health and care services during a period of expected growth in demand on services;

• avoiding unnecessary admissions to Acute Services and via Accident & Emergency –managing hospital beds and onward pressures on post-discharge, community-based health and care services during a period of projected growth in demand;

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• reducing the provision of care home placements for non complex needs and

delivering health and care services using the reablement model of Care at Home to support older people living independently at home for as long as possible;

• redesigning care home services to meet complex needs in the community while reducing the total overall number of care home places, aligned with action on increasing in Care at Home services.

5. Prevention 5.1 A key aim of the Reshaping Care for Older People agenda is to shift the balance of care

from bed based to community based services which support older people to live in their own home or homely setting for as long as possible. This translates into a key priority within our local 10 year plan, which will set out how partners will work together to achieve a shift in the balance of care locally. There has been a great deal of success in terms of hospital discharge activity, and due to a focused improvement programme across the partnership, Renfrewshire is now the best performing area in Scotland in terms of the reduction in bed days lost.


6.1 A stakeholder consultation event was held on 22 November 2013 to discuss key elements of the draft Plan, the proposed direction of travel in the key service areas in health and social care. The input from the stakeholder event is currently being analysed for its contribution to the final stages of the draft Plan. This event was the culmination of a series of consultations, formal and informal, with a range of stakeholders over the summer.

6.2 Social Work’s Community Link Team are developing proposals to further engage with the third and community sector around the Reshaping Care for Older People agenda, and will work with local groups and organisations to take these forward during 2014.

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1. Summary

1.1 The Clinical Services Review programme, Clinical Services Fit for the Future, was launched at a Greater Glasgow and Clyde Board meeting in February 2012. The programme aims to look at the shape of clinical services beyond 2015 to ensure that all services are fit to meet the demands of the ageing population, changing medical practice and care and with a focus on the streamlined provision of health and social care services in the community.

1.2 Several demonstrator programmes are being progressed as part of the Clinical Services Review, with a programme specifically being explored in relation to the Royal Alexandria Hospital in Paisley, with particular focus on the Paisley locality.

1.3 Discussions are currently underway between NHS Greater Glasgow and Clyde and Renfrewshire Council on the programme which will have a broad aim of developing and improving interface services likely to include timely access to primary care, community services available 24/7, co-ordinated care at crisis/transition points for those most at risk and hospital admission with early comprehensive assessment and supported discharge.

1.4 This is intended to be a first stage demonstrator programme which could be scaled up across the board area if successful.

2. Recommendations

2.1 It is recommended that Members of the Board note the content of the paper.



Joint Report by: Peter Macleod, Director of Social Work, Renfrewshire Council and

David Leese, Director, Renfrewshire CHP

CLINICAL SERVICES FIT FOR THE FUTURE


3. Background 3.1 A range of demographic pressures continue to impact on the demand for health and

social care services across Renfrewshire, and indeed across the NHS Greater Glasgow and Clyde Health board area. People are generally living longer and are more likely to have complex health conditions which require care and support from health and social care services.

3.2 Locally we have a significant number of services which are either integrated, co-located

or work closely together. Significant success has been achieved by local social work and health services in terms of reducing the number of bed days lost within hospitals through enhanced joint working and the provision of flexible and responsive community based services.

3.3 Admissions to hospital in the Greater Glasgow and Clyde board area remain above the Scottish level, and emergency admissions continue to increase and therefore further work is now required to tackle this issue in partnership. The Clinical Services Review demonstrator which is proposed for the Royal Alexandria Hospital will focus on admissions and on the interfaces between community, primary and hospital based care to prevent unnecessary admission. Further detail is provided within the attached report which was submitted to the Social Work Health and Wellbeing Policy Board in January 2014.

4. Resources

4.1 Discussions are currently underway with NHS Greater Glasgow Clyde on the required

funding for the demonstrator programme. 5. Prevention

5.1 The focus of the demonstrator will be on preventing unnecessary admission through

enhanced working between community, primary and hospital based services.


6.1 Opportunities for engagement around the demonstrator programme will be progressed

as appropriate, as part of local discussion and agreement on the implementation arrangements.

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1

___________________________________________________________________

To: Social Work, Health & Well-being Policy Board

On: 14 January 2014

___________________________________________________________________

Report by: Director of Social Work

___________________________________________________________________

Heading: Clinical Services Fit for the Future: Clinical Services Review Pilot

___________________________________________________________________

1. Summary

1.1 The Clinical Services Review programme, Clinical Services Fit for the Future, was launched at a Greater Glasgow and Clyde Board meeting in February 2012. The programme aims to look at the shape of clinical services beyond 2015 to ensure that all services are fit to meet the demands of the ageing population, changing medical practice and care and with a focus on the streamlined provision of health and social care services in the community.

1.2 The paper outlines the work arising from the Clinical Services Review and asks the Policy Board to consider the opportunity to develop a pilot programme for the Renfrewshire partnership which will build on the work to date on the Reshaping Care for Older People [Change Fund].

___________________________________________________________________

2. Recommendations

2.1 To note the findings of the NHS Greater Glasgow & Clyde Clinical ServicesReview.

2.2 To authorise the Director of Social Work to enter into discussion and todevelop the pilot site proposals for Renfrewshire initially, based within thePaisley locality.

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2.3 To note that a further update report will be provided to this Board on progress and the recommended next steps in May 2014.

_________________________________________________________

3. Background

3.1. The Clinical Services Review programme, Clinical Services Fit for the Future, was launched at a Greater Glasgow and Clyde Board meeting in February 2012. The programme aims to look at the shape of clinical services beyond 2015, with a supporting change programme in place until 2020. The strategy is based on a needs analysis, review of evidence from practice, research and innovation and a review of the current service delivery models, future changes [including demographics] and possible models of care.

Work has been carried out within the Board in eight clinically led workstreams –

Population health Emergency care and trauma Planned care Child and maternal health Older people’s services Chronic disease management Mental health

There has been consultation with key stakeholders, including patient and carer representatives.

3.2. The Case for Change

The health and care needs of the population are significant and changing. We have major challenges for all services to address the poor health outcomes and inequalities. It is clear that not enough focus on prevention and support for people at an early stage in their illness can lead to poorer health outcomes and to people then accessing services in crisis, which also tends to be more expensive. People, particularly those with complex conditions can often feel unsupported and find services complex and fragmented.

The demographic changes to the population have been clearly articulated through the range of reports presented to this Policy Board as part of the Reshaping Care for Older People [Change Fund] – the rise in demand for services will come at the same time as we are facing a period of significant

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financial constraint. By 2020 people over 65 years of age will comprise 15% of our population but will account for 41% of emergency admissions and 66% of bed days in hospital. There will be a significant growth in the number of people who have dementia – an 18% increase by 2020. One in three people aged over 65 will die with a form of dementia and one in four hospital inpatients will have dementia.

Advances in medical care mean that we are all living longer and an increasing number of people are living with long term conditions, including cancer. The majority of this group of people will be under 65 years of age. Around 60% of the total burden of disease is preventable and is linked to small group of risk factors including smoking, alcohol use, overweight and lack of exercise. The impact of mental health, poverty and the resulting inequalities cannot be underestimated. The onset of multi morbidity occurs some 10-15 years earlier in people living in the most deprived areas when compared with the least deprived areas. It is estimated that 70-80% of the population can manage their own illness with support. In Renfrewshire we are currently part of the United4Health programme which has a focus on the use of technology to support people to manage conditions such as respiratory conditions and diabetes. Current models of care tend to be focused on episodes rather than longer term management. To further develop good anticipatory care will require multi professional and multi agency services, with the ability to quickly access specialist advice and responsive care. Locally, we have been working to develop anticipatory care planning but it is not yet in use across all services. Greater Glasgow and Clyde Health Board have a higher admission rate to hospital than almost all other Scottish Boards, with a continued increase in the numbers of emergency admissions. As a partnership we have been consistently reducing the number of people delayed in their discharge, also reducing the number of bed days lost to delayed discharge and are one of the best performing partnerships in Scotland. However, admissions which are avoidable, place considerable pressure on all areas of services. Medical advances mean that most routine surgery is now done in one day, with the majority of people staying in hospital for less than three days. Continued advances mean that more people can be treated at home or locally, this includes people who require palliative care.

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3.3. Service Models Within the Clinical Services Review work to date the criteria for future services have been identified as –

Person/patient centred Integrated services between primary and secondary care Best use of resources Affordable and provided within the funding available Accessible and provided as locally as possible Safe and sustainable Adaptable, achieving change over time

The overarching aim of the redesigned service models is to “..provide a balanced system of care where people get the care in the right place from people with the right skills, working across the artificial boundary of hospital and community..” [NHS [b], page 7, 2013].

It is acknowledged within the review that working at the transition points between hospital and community services may involve new services, extending existing services, creating new ways of working through in reach, outreach and shared care, as well as change to the way we communicate and share information.

The approach outlined within the Clinical Services Review has a strong emphasis on health improvement and disease prevention. This approach will require support to the population to take responsibility for their own health by the promotion of healthier lifestyles.

The key characteristics of the clinical services required are defined as –

1. Primary Care – timely access to primary care services which provide a universal, comprehensive service.

Focal point for prevention, anticipatory care and early intervention.

Management where possible in primary care setting Focus for continuity of care and co ordination of care for

multiple conditions.

2. Community Services - integrated services across health, social care and the commissioned services provided by the independent and third sectors.

Single point of access, accessible 24/7 from acute and community settings.

Focused on preventing deterioration and supporting independence.

Multi disciplinary care plans in place to respond to crisis.

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Working in multi disciplinary teams for defined populations [this is likely to be locality based services].

3. Co-ordinated Care at Transition or Crisis - with a focus on people who are most at risk.

Access to specialist advice by phone, in community settings or through rapid access to outpatients.

Jointly agreed care plans with input from GP’s, community teams, specialist nurses and consultants with shared responsibility for implementation.

Rapid escalation of support, available on 24/7 basis.

4. Hospital Admission – focus on early comprehensive assessment. Senior clinical decision, makers at the front door. Specialist care available 24/7 where required. Rapid transfer to appropriate place of care, following

assessment. Inpatient stay for the acute period of care only. Early supported discharge home or step down care. Early involvement of primary and community care team in

planning for discharge.

Acute inpatient care is defined as “...where people receive specialised support in an emergency or following referral for surgery, complex tests or other things that cannot be done in the community. Acute care usually provides treatment for a short period, until the person is well enough to be supported in the community again.” [ NHS [b], page 10, 2013]. 5. Planned Care - locally accessible on an outpatient/ambulatory care

basis where possible. Wide range of specialist clinics in the community, working as

part of multi disciplinary team. Appropriate follow up. Diagnostic service organised around patient/person’s needs. Interventions provided as day case where appropriate. Rapid access as an alternative to emergency admission or to

facilitate discharge.

6. Low Volume and High Complexity Care – provided in defined specialist units equipped to meet care needs. An example of this would be coronary care.

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3.4. Development Programme Proposal

The next stage for the Clinical Services Review Programme is to test the proposals. The initial focus for a test will be adult services with the broad aim of developing and further improving interface services. That is likely to include timely access to primary care; community services available 24/7; coordinated care at crisis/transition points for those most at risk and hospital admission with early comprehensive assessment and supported discharge. It is proposed that the Paisley locality linking to the Royal Alexandra Hospital would be a large enough population group to test the models and assess impact. The Paisley locality is defined for the purposes of the pilot as the population registered with, and receiving services from the 13 GP practices in the PA1, PA2 and PA3 areas. This is a first stage pilot and it is hoped that, if successful, the services and delivery models can move to scale quickly to cover the full Renfrewshire and NHS Greater Glasgow and Clyde Board area. Locally we have a significant number of services which are either integrated, co located or work closely together. The Reshaping Care for Older People partnership is well established and has guided the development of care at home, reablement services, rehabilitation and enablement services [RES] via the NHS, telehealthcare [now also supported by the SmartCare and United4Health European programmes], dementia training, palliative care services, work with the third and independent sectors and most recently preventative services such as FoodTrain and the pilot for step down beds based within Montrose Care Home. The partnership is the most successful in Scotland in terms of the sustained reduction in bed days lost and continues to work to further develop services. Single access points to services are also already in place through ASert and will give a good foundation for further development. An initial discussion with NHS Greater Glasgow & Clyde has focused on potential programme support and management with a need to further develop the actual delivery mechanisms. Additional capacity will be required across both the NHS Rehabilitation and Enablement Services, the social work service both in terms of assessment and care management and the key care at home services [reablement and long term]. It is important that these are included as we move forward - while we can achieve some efficiency via pathways and improved working practices across the services we will need to provide increasing levels of care and support to people in their own homes. Further work is required on the governance arrangements to reflect and support the partnership between the NHS and local authority. A Children's CSR pilot is also being considered by the Health Board. However, this is at an early stage and the focus of discussion to date and in this report is on adult services.

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A further discussion following the decision of this Board will be held in January to consider the next steps, and to enter into further detail on the scope, delivery model, services and funding.

___________________________________________________________________

Implications of the Report

1. Financial - The Reshaping Care for Older People [Change Fund] is already working on a number of the key developments. Initial indications from the Health Board are that additional support funding will be made available. Work on the detail of this is still to take place.

2. HR & Organisational Development - the care at home and care home

services already work 24/7. There are likely to be some impacts for the locality based teams including the team based with the hospital. Initial discussion has taken place with HR and fuller discussion will take place as any pilot progresses with HR and relevant Trade Unions.

3. Community Planning – The Community Planning partners are part of the

Reshaping Care for Older People governance groups. The pilot will require full governance arrangements which have still to be worked through and agreed and will include the CPP.

Children and Young People – this pilot relates to adult services.

Community Care, Health & Well-being – as above in relation to Community Planning Partnership.

4. Legal - none. Pilot proposal is within the existing legislative framework for services and in line with Scottish Government policy.

5. Property/Assets – none.

6. Information Technology – not clear at this early stage.

7. Equality & Human Rights

(a) The Recommendations contained within this report have been assessed in relation to their impact on equalities and human rights. No negative impacts on equality groups or potential for infringement of individuals’ human rights have been identified arising from the recommendations contained in the report because the report is for noting progress and agreement to initial pilot development only. If required following implementation, the actual impact of the recommendations and the mitigating actions will be reviewed and monitored, and the results of the assessment will be published on the Council’s website.

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8. Health & Safety – none.

9. Procurement – none.

10. Risk – none.

11. Privacy Impact – none.

12. CoSLA Policy Position – The CSR proposals are in line with Cosla work to date on integration and services for older people and Scottish Government policy.

_________________________________________________________

List of Background Papers (a) NHS Greater Glasgow & Clyde [2013] Clinical Services Fit for the Future

nhsggc.org.uk (b) NHS Greater Glasgow & Clyde [2013] NHS GGC Clinical Services Fit for the

Future. Service Models. nhsggc.org.uk (c) NHS Greater Glasgow & Clyde [2013] Clinical Services Fit for the Future:

Clinical Services Review Update Paper The foregoing background papers will be retained within Social Work for inspection by the public for the prescribed period of four years from the date of the meeting. The contact officer within the service is Shiona Strachan, Head of Adult Services. ___________________________________________________________________ Author: Shiona Strachan, Head of Adult Services, Tel: 0141 618 6838

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MEMBERS OF THE - Our Renfrewshire · 2015-05-29 · Members of the press and public wishing to...

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